Meningioma treatment advances

Meningiomas are tumors that arise from the lining of the brain and spinal cord and are the most common type of primary brain tumor. While most meningiomas are considered benign, they can still cause significant symptoms and can be challenging to treat. Recent research advances are leading to better imaging tools and promising new treatments, including medications and new radiotherapy modalities, for meningioma management.

Penn Medicine physicians Christina Jackson, MD, and Emily Lebow, MD, sat down with the Penn Medicine Physician Interviews Podcast to discuss these exciting advances and share how the care of meningiomas has evolved.

A neurosurgeon, Dr. Jackson specializes in open, minimally invasive, and endoscopic skull-based approaches. As a radiation oncologist, Dr. Lebow has extensive experience in treating tumors in the brain and spinal cord.

“Over the past decade, there’s been an increasing interest and focus on better understanding the biology of these tumors,” Dr. Jackson says. “I’m proud to say that at Penn Medicine, we are at the forefront of discovering new therapies and targets that allow us to develop new medications and to refine existing treatment modalities to treat these tumors in a novel way.”

How are meningiomas treated?

Although meningiomas are generally benign, they can cause significant and sometimes disabling symptoms—if, for example, they press against surrounding brain tissue, compress the optic nerve, or affect hormone function because of their proximity to the pituitary gland.

What’s more, a subset of more aggressive meningiomas can be considered malignant, either because they recur repeatedly, grow at a rapid rate, or show atypical or malignant features under the microscope. “These higher-grade meningiomas can be very difficult to control, even with very aggressive surgery and radiation,” Dr. Jackson notes.

Treatment of meningiomas generally falls into four categories:

• Observation: For most patients, if tumors are small and asymptomatic, it’s appropriate to take a watchful waiting approach. Patients are scanned at certain intervals, so physicians can track growth patterns and determine if and when intervention is needed.
• Surgery: Surgery is often the first-line therapy in patients with large meningiomas or tumors causing symptoms. These procedures can involve removal of the tumor as well as the surrounding meninges and, in some cases, removal of affected bone.
• Radiation: Radiotherapy is often an important component of treatment. At Penn Medicine, this includes advanced approaches such as proton therapy, Gamma Knife® therapy, and emerging approaches such as GammaTile.
• Medications: Traditional chemotherapy is not highly effective in controlling meningiomas. But in recent years, several promising new targeted therapies have been developed for these tumors.

Because meningiomas are complex and heterogeneous, patients benefit from a multidisciplinary approach to treatment. At Penn Medicine, this team includes experts in neurosurgery, radiation oncology, rhinology, skull-based ENT, neuro-oncology, and oculoplastics. Patients may also work before or after surgery with physical, occupational, and speech therapists to address challenges that arise from lesion growth or treatments.

“We need that multidisciplinary input to pick the right combination of treatments at the right time for the right patient,” Dr. Lebow says.

Advances in meningioma management

Experts at Penn Medicine are at the forefront of developing and studying new approaches for treating meningiomas. Advances in understanding the biology of meningiomas, for example, have led to new targets and encouraging new treatments.

“Utilizing a wide range of advanced next-generation meningioma treatments allows us to really achieve the best possible balance between controlling the meningioma but also minimizing long-term side effects that can be detrimental to quality of life,” Dr. Lebow says.

Drs. Lebow and Jackson discussed several promising advances for treating these often-complex tumors.

DOTATATE PET imaging

Somatostatin is a peptide that is highly expressed in meningiomas. A new imaging test known as DOTATATE PET takes advantage of that expression. The test uses a radioactive tracer that binds to somatostatin receptors to identify the extent of the affected tissue.

“As a surgeon, this is especially useful for me when targeting tumors along the skull base where there’s a lot of bony involvement,” Dr. Jackson says. “DOTATATE PET allows me to plan my surgeries ahead of time, including planning reconstructive techniques preoperatively so that we can develop custom implants in anticipation for the resected bone after surgery.”

This advanced imaging can also be useful for determining whether adjuvant radiotherapy may be beneficial after surgery. “I’ll often rely on this modality to help better inform my understanding of the true extent of residual disease so I can have a very informed discussion with patients,” Dr. Lebow adds.

Lutathera

Lutathera is a targeted therapy that also takes advantage of somatostatin overexpression. The medication combines the tumor-targeting DOTATATE molecule with a radioactive isotope. Because it delivers the radiotherapy only to cells expressing the somatostatin receptor, the therapy can be very effective at controlling residual meningiomas that cannot be safely resected—while minimizing toxicity to healthy tissues. “This is an emerging technique, but we’re seeing very compelling results, and we’re excited that we will be able to make this therapy available for patients at Penn Medicine,” Dr. Jackson says.

GammaTile

GammaTile is another new radiotherapy treatment that’s proving very beneficial, Dr. Jackson notes. During surgical resection, the surgeon places radioactive brachytherapy tiles along the margin of the resected cavity to kill microscopic tumor cells that might remain hidden along the margin. That allows patients to have surgery and radiation in the same setting, avoiding the need to come back for radiotherapy treatment after surgery. GammaTile is also helpful as an additional modality for treating patients who may not otherwise be good candidates for traditional radiation therapy. It’s also helpful as an additional modality for treating patients who may not otherwise be good candidates for traditional radiation therapy.

Targeted treatments

Traditionally, meningiomas have been treated without consideration for their molecular and genetic profile. But advances in understanding have led to more targeted treatments. “In 2026, at Penn Medicine, we are performing molecular profiling on almost all resected meningiomas. This gives us critical information about genetic alterations and biological vulnerabilities in these tumors,” Dr. Lebow says.

Molecular profiling allows physicians to choose medications, including new oral drugs such as MEK inhibitors, that target subsets of meningiomas. These targeted treatments appear to be much more promising than broad chemotherapy agents used in the past, Dr. Jackson adds. Penn Medicine is actively recruiting patients for a clinical trial testing different targeted therapies chosen based on a tumor’s molecular profile.

The future of meningioma treatment at Penn Medicine

With so many new and emerging options for treating meningiomas, treatment decisions can be complex. That makes it even more essential for experts from different disciplines to work together to discuss treatment approaches and manage patient care.

“In this setting, it is so important to have an evaluation with a multidisciplinary team who routinely cares for meningiomas and can refer patients for comprehensive sequencing, multidisciplinary evaluation, and personalized care,” Dr. Lebow says.

As meningioma science continues to evolve, researchers at Penn Medicine are helping to realize the future of meningioma care, Dr. Jackson adds. “We’re really shifting into an era of precision medicine and targeted therapies for meningioma patients,” she says. “I’m excited about that and about Penn Medicine’s contributions, and we’re looking forward to treating those patients.”

Referrals and consultations

For a provider-to-provider consultation with Dr. Jackson or Dr. Lebow, call 877-937-7366, or refer a patient online.